This has been a fairly grouchy day, for no particularly good reason. Dr. Isakson paged me at 10 (after I’d wasted an hour for lack of anything to do) to say that we had four new patients, and I could go see them all, and we would round at 2; and let him know if I couldn’t get them all done.

I am really hoping that I would be able to see surgery consults at a rate faster than 1/hour; but medicine-type consults for me tend to go pretty slowly: 15 minutes for getting lost on the way there, finding the patient (invariably not in their room, or busy with someone else), finding the chart (invariably buried at the bottom of the social worker’s stack), and finding a free computer; 15 minutes for reviewing the chart and making careful notes so I can present it properly; 15 minutes for talking to the patient (less if they’re completely demented and nonverbal, more if they’re only partially demented and very tangential); and 15 minutes for writing the H&P, and longing for the day when I can dictate these things. Obviously there are places in there for being more efficient, particularly the “getting lost” section. I spent a fair while this morning wandering through the four different buildings which make up this hospital, which each have two identical looking elevator shafts on opposite sides of themselves, and whose floor numbers don’t match at all, and without any idea of which patient room number went with which building. Grrr.

I gave up after the second one and decided that I would not accrue any more virtue, or good temper, by skipping lunch. Hospital cafeterias are usually interesting for about one week after one meets the hospital; after that you know everything on the menu, and what’s wrong with every delectable sounding title. . . Then the only fun left is calculating how many objects you can fit into the med student allowance (I never thought those grade-school addition exercises would be this useful).

The last patient of the day was the best: the label in the computer says “alcohol abuse.” I couldn’t figure out why a neurologist would need to see him for that, so in disgust I was trying to avoid seeing him (I don’t think “student not see patient” is a potential category in Dr. Isakson’s mind, so it didn’t work). Turns out he passed out, after incidentally drinking his one glass of wine per week. Very nice guy, gave the most coherent history all day, and was actually conscious enough to do the whole neuro exam on. Unfortunately I’m afraid his incidental chest xray caught a tumor, and a fairly large on at that.

But he was a nice change from old ladies who smile and make absolutely no response to all questions and commands, or ladies who can’t hear half of what you yell, and then argue about every question, and ignore all requests. . . This was the gem, when Dr. Isakson arrived: “Please repeat after me: ‘No ifs, ands, or buts.'” “What? You’re interested in my body parts? Ha! I never thought I’d hear that one again. <laughter>” I gave up and laughed too.

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